| NPI | 1003226036 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0007819) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA6749) |
| 363AM0700X Physician Assistant, Medical (Licence: VA 0110-004568) | |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2021-08-26 |